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Criminology Risk Assessment
by
Ashley A. Pritchard, Adam J. E. Blanchard, Kevin S. Douglas

Introduction

Violence risk assessment is the process of identifying the level of risk for future violence posed by offenders, forensic patients, and civil psychiatric patients. In each such context, whether persons are detained or released into the community is a decision governed by law. The field of violence risk assessment has witnessed tremendous growth over the past several decades. With few exceptions, its use in numerous legal settings has been upheld by courts, and in some cases professionals have positive duties to conduct risk assessments and protect potential victims. After early research findings suggesting very poor performance of clinicians in predicting violence, a great deal of research has focused on improving risk assessment. Several hundred studies have now been conducted on structured approaches to risk assessment (e.g., actuarial prediction, structured professional judgment). Similarly, a great amount of scientific attention has been paid to identifying empirically supported violence risk factors. More recently, scholars have been focusing on identifying so-called dynamic risk factors, or those that are changeable and of most relevance to intervention. Current themes in risk assessment include focusing on how risk assessment can inform risk management and risk reduction and how best to integrate risk assessment technology into actual practice.

General Overviews

Early reviews of violence risk assessment tended to focus on failures in clinical prediction and consequent challenges to its use in legal arenas (Ennis and Litwack 1974). Additionally, reviews often attempted to specify what the important risk factors were (Douglas and Webster 1999). Over time, reviews shifted to explicating certain models of risk assessment, such as the actuarial approach (Quinsey, et al. 1998), the risk-need-responsivity approach (Andrews, et al. 2010), the structured professional judgment approach (Douglas and Reeves 2008), or all such approaches (Litwack, et al. 2006). Most recently, there has been a shift toward general overviews that focus on quantifying individual studies meta-analytically (Yang, et al. 2010) as well as on applied aspects of risk assessment such as case formulation (Lewis and Doyle 2009).

  • Andrews, D. A., J. Bonta, and J. S. Wormith. 2010. The level of service (LS) assessment of adults and older adolescents. In Handbook of violence risk assessment. Edited by R. Otto and K. S. Douglas, 199–225. New York: Routledge.

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    In this book chapter, the authors discuss the history and development of a method of risk and needs assessment called risk-needs-responsivity, or RNR. The RNR approach was developed primarily within correctional settings, and it guides decision-makers through the assessment of risk factors and the development of risk management plans.

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  • Douglas, K. S., and K. Reeves. 2008. Violence risk assessment. In Encyclopedia of psychology and law. Vol. 2. Edited by B. L. Cutler, 448–451. Thousand Oaks, CA: SAGE.

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    This piece provides an overview of various forms of risk assessment, focusing on the structured professional judgment approach.

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  • Douglas, K. S., and C. D. Webster. 1999. Predicting violence in mentally and personality disordered individuals. In Psychology and law: The state of the discipline. Edited by R. Roesch, S. D. Hart, and J. R. P. Ogloff, 175–239. New York: Plenum.

    DOI: 10.1007/978-1-4615-4891-1Save Citation »Export Citation »E-mail Citation »

    This chapter first provides a description of the history of risk assessment and its legal context. It then moves into a detailed description of research support for numerous violence risk factors.

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  • Ennis, B. J., and T. R. Litwack. 1974. Psychiatry and the presumption of expertise: Flipping coins in the courtroom. California Law Review 62:693–752.

    DOI: 10.2307/3479746Save Citation »Export Citation »E-mail Citation »

    In this article, the authors review the small number of studies on the clinical prediction of violence, and they argue that the evidence indicated that predictive accuracy was low. As such, the authors opine that mental health professionals ought not to be involved in risk assessment within legal arenas.

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  • Lewis, G., and M. Doyle. 2009. Risk formulation: What are we doing and why? International Journal of Forensic Mental Health 8:286–292.

    DOI: 10.1080/14999011003635696Save Citation »Export Citation »E-mail Citation »

    In this article, the authors make the argument that risk assessment would benefit from increased attention to the formulation of risk at the individual level. It includes a description of different approaches to formulation.

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  • Litwack, T., P. Zapf, J. Groscup, and S. D. Hart. 2006. Violence risk assessment: Research, legal, and clinical considerations. In Handbook of forensic psychology. Edited by I. Weiner and A. Hess, 487–533. New York: Wiley.

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    This chapter provides a detailed discussion of clinical, actuarial, and structured professional judgment approaches to violence risk assessment. It reviews and critiques individual studies in detail, and it provides guidance for clinicians needing to conduct violence risk assessments. It also provides a detailed legal review.

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  • Quinsey, V. L., G. T. Harris, G. T. Rice, and C. A. Cormier. 1998. Violent offenders: Appraising and managing risk. Washington, DC: American Psychological Association.

    DOI: 10.1037/10304-000Save Citation »Export Citation »E-mail Citation »

    In this book, the authors provide a detailed discussion of their views of the benefits of actuarial risk assessment. They also describe a series of research studies that culminated in the development of an actuarial violence risk assessment instrument.

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  • Yang, M., S. C. P. Wong, and J. Coid. 2010. The efficacy of violence prediction: A meta-analytic comparison of nine risk assessment tools. Psychological Bulletin 136.5: 740–767.

    DOI: 10.1037/a0020473Save Citation »Export Citation »E-mail Citation »

    This meta-analysis evaluated the predictive accuracy of nine risk assessment instruments across twenty-eight samples. The authors report that there were few differences between the tools. Few tools improved upon the Psychopathy Checklist-Revised, save for the Historical-Clinical-Risk Management 20 (HCR-20) and the Offender Group Reconviction Scale (OGRS).

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Legal Developments

Legislation and case law in North America, Europe, and elsewhere have solidified the role of violence risk assessment in numerous criminal and civil settings. Although the validity and constitutionality of violence risk assessment has been challenged in many legal cases, generally such cases have upheld the admissibility and constitutionality of risk assessment. Early cases spurred interest among researchers in violence risk assessment.

Important Legal Landmarks

Landmark legal cases from the 1960s to the 1980s in the United States solidified the role of violence risk assessment in contexts such as provision of mental health services (Tarasoff v. Regents of the University of California) and criminal/death penalty sentencing (Barefoot v. Estelle). The US Supreme Court case of Baxstrom v. Harold spurred scientific interest in risk assessment (as seen in Monahan 1981 and Steadman and Cocozza 1974). Legislative developments, such as sexually violent predator (SVP) laws in the United States, have further solidified the use of violence risk assessments in the United States (Melton, et al. 2007). Similarly, legislative and common law developments in other jurisdictions, such as Canada and Europe, have resulted in the entrenchment of violence risk assessment in various legal settings (Wilson and Douglas 2009).

  • Barefoot v. Estelle. 463 US 880 (1983).

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    In this case, the US Supreme Court upheld the constitutionality of psychiatrists offering predictions of future violence in the context of the sentencing stage of death penalty cases.

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    • Baxstrom v. Herold. 383 US 107 (1966).

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      The US Supreme Court held that the post-sentence detainment of persons on the basis of mental disorder and past violent criminality, and not having received a new hearing to evaluate current risk, violated the equal protection clause of the US Constitution. Approximately one thousand persons were transferred to less secure civil facilities or released. Follow-up studies revealed that few patients committed new violent offenses, and, hence, their risk for violence was overestimated (see Steadman and Cocozza 1974).

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      • Melton, G. B., J. Petrila, N. G. Poythress, and C. Slobogin. 2007. Psychological evaluations for the courts: A handbook for mental health professionals and lawyers. 3d ed. New York: Guilford.

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        In chapter 9 of this book, the authors provide a legal overview of SVP laws in the USA. They discuss case law that has upheld the constitutionality of such laws, and they provide a list of the states that have these laws as of the time of writing.

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      • Monahan, J. 1981. Predicting violent behavior: An assessment of clinical techniques. Beverly Hills, CA: SAGE.

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        This monograph reviews the state of the discipline of risk assessment based on the handful of early studies. Monahan concludes that most clinical predictions of violence were inaccurate, although he opines that certain approaches (e.g., short-term predictions, predictions based on known risk factors) held greater promise and encouraged a renewed effort at undertaking research.

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      • Steadman, H. J., and J. J. Cocozza. 1974. Careers of the criminally insane: Excessive social control of deviance. Lexington, MA: Lexington.

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        In this book, the authors review their in-depth analysis of what happened to the offenders who were subject to the Baxstrom decision (see Baxstron v. Herold 1966). Roughly one in five of the 967 offenders were determined to be assaultive. Of 121 who had been released to the community, only 8 percent committed a new offense and only one of these new offenses was violent. This study prompted researchers to pursue more valid risk assessment approaches.

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      • Tarasoff v. Regents of the University of California. 551 P2d. 334 (1976).

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        The Supreme Court of California decided that mental health professionals have a legal duty to protect identifiable potential victims from their clients or patients who they ought to have deemed pose a risk of serious violence. Although not applicable in all US states, this case entrenched in case law the proposition that mental health professionals have the ability to assess risk and have a duty to act on such information.

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        • Wilson, C. M., and K. S. Douglas. 2009. Assessment of dangerousness. In Encyclopedia of forensic science. Edited by C. Edwards. Hoboken, NJ: Wiley.

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          The authors discuss historical legal developments that have embedded violence risk assessment in laws in North America and Europe. Examples are provided from both criminal and civil contexts. They review legislation and case law upholding challenges thereto.

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        Development of Risk Assessment Approaches

        This section explores the development of risk assessment. For the past one hundred years, risk assessment has grown and evolved. The various generations proposed by prominent researchers in the field will be discussed as well as the correspondence between the two areas from which they arose.

        Context of Risk Assessment Development

        Risk assessment arose independently out of the fields of mental health and corrections. Monahan, et al. 2001 develops its risk assessment tool in a mental health context, whereas the authors of Andrews, et al. 1990 developed their assessment instruments within a correctional setting.

        • Andrews, D. A., J. Bonta, and R. D. Hoge. 1990. Classification for effective rehabilitation: Rediscovering psychology. Criminal Justice and Behavior 17:19–52.

          DOI: 10.1177/0093854890017001004Save Citation »Export Citation »E-mail Citation »

          This article discusses how to properly rehabilitate offenders. The authors go into detail describing the four principles for successful risk assessment and rehabilitation, which are risk, need, responsivity, and professional override. This model forms the basis for several risk assessment instruments intended to be used within the adult or juvenile justice systems.

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        • Monahan, J., H. J. Steadman, E. Silver, et al. 2001. Rethinking risk assessment: The MacArthur study of mental disorder and violence. New York: Oxford Univ. Press.

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          Chapter 1 provides a brief background into societal attitudes and how they influenced the treatment of individuals with mental disorders. Chapter 1 also provides support for the use of established risk assessment tools.

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        Monahan’s Generations

        Monahan divided the history of risk assessment into two generations. The first generation of risk assessment constituted the period when professionals used clinical judgment to make decisions; however, research showed that prediction was poor, as seen in Monahan 1984 and Doyle and Dolan 2002. Actuarial assessment partly characterized the second generation of risk assessment, along with suggestions for research on shorter-term predictions, and it was argued to be superior to clinical judgment, as seen in Monahan 1984, Monahan 1988, and Doyle and Dolan 2002. The third generation of risk assessment (not proclaimed by Monahan) aimed to incorporate the systematic approach of actuarial assessments but lessen their inflexibility; structured professional judgment was the result according to Doyle and Dolan 2002. Monahan 1996 outlines research spanning forty years, past and future. Steadman, et al. 1994 describes a pivotal study in the area of risk assessment.

        • Doyle, M., and M. Dolan. 2002. Violence risk assessment: Combining actuarial and clinical information to structure clinical judgments for the formulation and management of risk. Journal of Psychiatric and Mental Health Nursing 9.6: 649–657.

          DOI: 10.1046/j.1365-2850.2002.00535.xSave Citation »Export Citation »E-mail Citation »

          An easy-to-read article that provides descriptions of the well-known Monahan generations. The description of the generations is paired with advantages and disadvantages of the approach. Instruments and formulation of risk are also discussed briefly.

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        • Monahan, J. 1984. The prediction of violent behavior: Toward a second generation of theory and policy. American Journal of Psychiatry 141:10–15.

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          A quick read that provides a description of Monahan’s view of what constitutes first and second generations of risk assessment. The article contains a description of what the first generation of risk assessment research entailed, which, in a nutshell, demonstrated that professionals, using techniques available during the 1970s and earlier, were terrible at violence prediction.

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        • Monahan, J. 1988. Risk assessment of violence among the mentally disordered: Generating useful knowledge. International Journal of Law and Psychiatry 11:249–257.

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          Four problems are outlined that had been present in the second generation of risk assessment research (predictor variables were poor; criterion variables were weak; two types of studies were used, thus using only two validation samples; collaboration in research efforts was lacking). Monahan describes each problem and provides solutions to improve the state of research by implementing these strategies in research.

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        • Monahan, J. 1996. Violence prediction: The past twenty and the next twenty years. Criminal Justice and Behavior 23.1: 107–120.

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          Monahan discusses cases and research from 1974 to 1994. In addition, the article outlines what research should consider for the next twenty years, which at the time spanned the period from 1995 to 2015.

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        • Steadman, H. J., J. Monahan, P. S. Appelbaum, et al. 1994. Designing a new generation of risk assessment research. In Violence and mental disorder: Developments in risk assessment. Edited by J. Monahan and H. J. Steadman, 297–318. Chicago: Univ. of Chicago Press.

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          The MacArthur Risk Assessment Study is a very important study in risk assessment. The authors of this chapter describe what they had done to prepare for the study. Seven characteristics that were seen as important for the new generation for risk assessment were outlined (e.g., a goal of research must be risk management in addition to risk assessment).

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        Andrews and Bonta’s Generations

        Unlike Monahan’s generations, Andrews and Bonta separated the history of risk assessment into four generations. The first two generations are similar to Monahan’s. Clinical judgment is characteristic of the first generation of risk assessment, while the second generation is composed of actuarial assessment that uses static risk factors, as seen in Andrews and Bonta 2010, Bonta and Andrews 2007, and Bonta 1996. The third generation of risk assessment began in the early 1980s and incorporates dynamic risk factors, as seen in Andrews and Bonta 2010, Bonta and Andrews 2007, and Bonta 1996. The inclusion of dynamic risk factors has allowed for offender needs to be taken into account and measured. Finally, use of risk assessment and management together is what constitutes the fourth generation, as seen in Andrews and Bonta 2010 and Bonta and Andrews 2007.

        • Andrews, D. A., and J. Bonta. 2010. The psychology of criminal conduct. 5th ed. Cincinnati: Anderson.

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          The four generations of risk assessment are described in detail in chapter 10 with a special emphasis on the following tools: The Level of Service Inventory-Revised (LSI-R), the Level of Service/Risk, Need, Responsivity (LS/RNR), and the Level of Service/Case Management Inventory (LS/CMI). Prediction and RNR principles are mentioned.

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        • Bonta, J. 1996. Risk-needs assessment and treatment. In Choosing correctional options that work: Defining the demand and evaluating the supply. Edited by A. T. Harland, 18–32. Thousand Oaks, CA: SAGE.

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          Bonta explains the three generations of risk assessment, acknowledging that the fourth generation is on its way. This chapter is clearly written and gives concise explanations.

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        • Bonta, J., and D. A. Andrews. 2007. Risk-need-responsivity model for offender assessment and rehabilitation. Corrections Research User Report 2007-06. Ottawa: Public Safety Canada.

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          This report clearly outlines the history of risk assessment in the context of the four generations. The history is accompanied by an explanation of the risk-need-responsivity model. Additionally, offender rehabilitation is discussed, which includes past perspectives and current thinking about what works to reduce crime and violence.

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        Correspondence of the Two Streams

        It is important that mental health be considered in a correctional setting. The prevalence of mental disorders is higher in correctional settings than in community settings (Weinstein, et al. 2005). Lurigio and Harris 2009 deals with the topic of mental disorder and risk assessment, specifically violent risk assessment. These works summarize research in concluding that violence was not associated with mental illness alone.

        • Lurigio, A. J., and A. J. Harris. 2009. Mental illness, violence, and risk assessment: An evidence-based review. Victims & Offenders 4.4: 341–347.

          DOI: 10.1080/15564880903260561Save Citation »Export Citation »E-mail Citation »

          This article provides a good example of how the field of mental health and the criminal justice system interact in terms of violence risk assessment. Research on the link between violence and mental disorders is included.

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        • Weinstein, H. C., D. Kim, A. H. Mack, K. E. Malavade, and A. U. Saraiya. 2005. Prevalence and assessment of mental disorders in correctional settings. In Handbook of correctional mental health. Edited by C. L. Scott and J. B. Gerbasi, 43–68. Washington, DC: American Psychiatric.

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          This chapter provides an estimate of the prevalence of mental disorders in a correctional setting. In addition, assessment for mental disorders and violence is discussed.

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        Application and Context

        Risk assessment has developed substantially since its emergence in the field. Researchers have determined that different tools should be used for specific contexts and outcomes. Additionally, various approaches have been forwarded, including unstructured clinical predication, anamnestic risk assessment, actuarial risk assessment, and structured professional judgment.

        Context

        Risk assessment is used in a variety of circumstances and situations. Situations occur both in the criminal system and in the civil justice system, as discussed in Shah 1978 and Lyon, et al. 2001. Also to consider, some have argued that the focus of risk assessment should not be on prediction per se, but on prevention, including Douglas and Kropp 2002. Further, in any circumstance there are certain issues (e.g., information from a third party) that Melton, et al. 2007 discusses in its third chapter.

        • Douglas, K. S., and P. R. Kropp. 2002. A prevention-based paradigm for violence risk assessment: Clinical and research applications. Criminal Justice and Behavior 29:617–658.

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          The authors of the article affirm that risk assessment is more about prevention than prediction. This article outlines research procedures that can be used to further knowledge in the area of prevention. Different contexts are touched on in the discussion (e.g., prison).

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        • Lyon, D. R., S. D. Hart, and C. D. Webster. 2001. Violence risk assessment. In Introduction to psychology and law: Canadian perspectives. Edited by R. Schuller and J. R. P. Ogloff, 314–350. Toronto: Univ. of Toronto Press.

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          This chapter discusses seventeen legal contexts in which risk assessment is necessary, specifically violence risk assessment. Many situations both in the civil and in the criminal justice system require risk assessment to make informed decisions. The chapter also provides details on important risk factors and on the Canadian perspective and approaches to assessment.

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        • Melton, G. B., J. Petrila, N. G. Poythress, and C. Slobogin. 2007. Psychological evaluations for the courts: A handbook for mental health professionals and lawyers. 3d ed. New York: Guilford.

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          Chapter 3 discusses forensic assessment generally; issues and considerations for assessment are outlined. Overall, this text is appropriate for use in a graduate class or for professionals who are learning how to conduct forensic evaluations.

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        • Shah, S. A. 1978. Dangerousness: A paradigm for exploring some issues in law and psychology. American Psychologist 33:224–238.

          DOI: 10.1037/0003-066X.33.3.224Save Citation »Export Citation »E-mail Citation »

          A must-read article by a prominent researcher in the field of risk assessment. Shah discusses dangerousness, or the likelihood of violence, and fifteen legal contexts that require risk assessment. Further, issues of importance at the time are discussed in detail, such as public opinion on error and imprisonment (confinement vs. release) as well as suggestions to better the state of psychology and law.

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        Approaches

        In the broadest sense, the different approaches to risk assessment can generally be separated into structured and unstructured approaches. Each of these two categories can be further subdivided to arrive at the four different types of risk assessment commonly recognized by professionals. The unstructured category includes unstructured clinical prediction and anamnestic assessment. The structured category includes actuarial assessment and structured professional judgment.

        Unstructured Clinical Prediction

        Unstructured clinical prediction is historically the most utilized method in violence prediction (see Doyle and Dolan 2002). Clinical discretion and intuition, based on the experience and qualifications of the clinician, form the basis of the decision-making process in this approach. That is, clinicians hold absolute discretion regarding the selection of information to consider, how to interpret this information, and how to combine the information to arrive at a final decision (Hart 1998). Essentially, the clinician gathers whatever information he or she considers relevant and processes that information in whatever way they deem appropriate (Nikolova, et al. 2009). Then, the clinician relies on his or her clinical judgment and intuition in arriving at an ultimate decision (Lavoie and Douglas 2008). The strengths and weaknesses of this approach are highlighted in several sources, such as Hart 1998 and Lavoie and Douglas 2008, and several include some of the prominent empirical support, as seen in Doyle and Dolan 2002 and Nikolova, et al. 2009. Monahan 1984 also places a discussion of this approach in the broader framework of the author’s “generations” of risk assessment. Methodological issues, policy implications, and professional considerations are also discussed in Hart 1998 and Monahan 1984.

        • Doyle, M., and M. Dolan. 2002. Violence risk assessment: Combining actuarial and clinical information to structure clinical judgments for the formulation and management of risk. Journal of Psychiatric and Mental Health Nursing 9.6: 649–657.

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          Distinguishes between clinical and actuarial approaches to risk assessment placing them within Monahan’s generations, highlighting the strengths, weaknesses, and empirical support of each approach. Further, discusses the structured professional judgment paradigm as an extension of the formerly mentioned approaches.

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        • Hart, S. D. 1998. The role of psychopathy in assessing risk for violence: Conceptual and methodological issues. Legal and Criminological Psychology 3:121–137.

          DOI: 10.1111/j.2044-8333.1998.tb00354.xSave Citation »Export Citation »E-mail Citation »

          Highlights the key differences and the implications of the differences between unstructured clinical judgment and actuarial risk assessment. Emphasizes the role that professionals make in the risk assessment process and methodological issues fundamental to any assessment approach.

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        • Lavoie, J. A. A., and K. S. Douglas. 2008. Risk assessment approaches. In Encyclopedia of psychology and law. Vol. 2. Edited by B. L. Cutler, 698–701. Thousand Oaks, CA: SAGE.

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          Provides an in-depth look at the various risk assessment approaches, including discussions of the theoretical framework of each approach and their advantages and disadvantages, without evaluating empirical data. This work provides a good introduction to readers who are unfamiliar with the different approaches to risk assessment.

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        • Monahan, J. 1984. The prediction of violent behavior: Toward a second generation of theory and policy. American Journal of Psychiatry 141:10–15.

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          Describes the emergence of the prediction of dangerousness using the unstructured clinical approach and the subsequent emergence of a “second generation” of theory and research that is supported. Numerous policy implications are also discussed in this fundamental work.

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        • Nikolova, N., D. S. Strub, and K. S. Douglas. 2009. Violence risk assessment. In Encyclopedia of forensic science. Edited by C. Edwards. Hoboken, NJ: Wiley.

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          In addition to providing a historical and contextual framework to risk assessment, this work emphasizes the differences among the main approaches to risk assessment. Notably, this work includes updated empirical data regarding the different approaches.

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        Anamnestic Risk Assessment

        Anamnestic assessment is sometimes considered a subclass of unstructured clinical judgment, as discussed in Melton, et al. 2007 and Otto 2000. This approach imposes a limited degree of constraint on the assessor in that they must identify the specific causes and correlates of violence and the underlying risk factors for the given individual, as seen in Douglas and Kropp 2002. In this sense, the assessor must identify the specific factors that led to this individual’s prior perpetration of violence. Through in-depth analyses of any previous acts of violence, the assessor attempts to identify themes or commonalities across previous violent episodes to determine the risk of a similar violent episode occurring (see Otto 2000). Through a full understanding of these prior acts of violence and on an examination of the contextual and interpersonal risk factors and interactions of risk factors that led to these acts, clinicians should be able to make informed judgments regarding the risk posed by an individual and the management strategies needed to mitigate this risk, as seen in Heilbrun and Kramer 2001 and Melton, et al. 2007. The individualistic nature of this type of risk assessment is noteworthy (see Melton, et al. 2007). Additionally, several sources discuss the advantages and disadvantages of this approach in comparison to its alternatives, including Douglas and Kropp 2002 and Otto 2000.

        • Douglas, K. S., and P. R. Kropp. 2002. A prevention-based paradigm for violence risk assessment: Clinical and research applications. Criminal Justice and Behavior 29.5: 617–658.

          DOI: 10.1177/009385402236735Save Citation »Export Citation »E-mail Citation »

          This article provides a rich theoretical framework within which the authors contrast the different assessment approaches. Working within a “prevention-based model of risk assessment,” the theoretical underpinnings of each approach are discussed.

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        • Heilbrun, K., and G. M. Kramer. 2001. Update on risk assessment in mentally disordered populations. Journal of Forensic Psychology Practice 1:55–63.

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          Focusing on a discussion of risk assessment with noncriminal mentally disordered individuals, the authors posit that, in comparison to the other approaches, anamnestic assessment is a good option when the intent is intervention rather than prediction.

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        • Melton, G. B., J. Petrila, N. G. Poythress, and C. Slobogin. 2007. Psychological evaluations for the courts: A handbook for mental health professionals and lawyers. 3d ed. New York: Guilford.

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          Emphasizing the legal nature of many risk assessments and the legal framework of the process. The authors critique different approaches to risk assessment. The individualistic nature of anamnestic assessment is highlighted. Numerous policy and legal considerations are reviewed.

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        • Otto, R. K. 2000. Assessing and managing violence risk in outpatient settings. Journal of Clinical Psychology 56.10: 1239–1262.

          DOI: 10.1002/1097-4679(200010)56:10%3C1239::AID-JCLP2%3E3.0.CO;2-JSave Citation »Export Citation »E-mail Citation »

          Provides an in-depth analysis of different approaches to risk assessment, including their strengths and weaknesses, from a mostly theoretical standpoint. This article is of importance to all audiences interested in risk assessment as it also provides a discussion relevant to many other areas of risk assessment.

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        Actuarial Risk Assessment

        The actuarial approach eliminates, as much as possible, the role of the clinician or professional in arriving at a final decision (see Dawes, et al. 1989). Meehl 1954 defines the statistical, or actuarial, approach as the use of an explicit method for combining information in order to arrive at a prediction, and this prediction should then be linked to a probability figure based on empirical findings (see also Dawes, et al. 1989). That is, assessors reach an ultimate decision based on statistical information according to explicit rules. As such, it typically involves using an algorithm, formula, or table to arrive at a decision (Grove and Meehl 1996). Actuarial prediction is usually empirically based, meaning the predictor variables, weighting of variables, and actuarial equation are based on a development sample that has been empirically investigated (Garb 2003); subsequently, a fixed decision rule is statistically established that has the strongest predictive accuracy in the development sample (Heilbrun, et al. 2010). Quinsey, et al. 2006 provides not only a description of an actuarial instrument, but also the course the authors used in developing such an instrument. Furthermore, empirical research has tended to support the validity and reliability of this approach over the unstructured clinical approach, as seen in Dawes, et al. 1989; Grove and Meehl 1996; and Meehl 1954. Garb 2003 discusses the actuarial-clinical debate in a broader context, as much of the empirical research has done, whereas Heilbrun, et al. 2010 grounds this debate specifically in the violence risk context. Finally, Andrews and Bonta 2010 describes and critiques this approach as necessarily antecedent to newer models of risk assessment. As well, Hannah-Moffat, et al. 2009 discusses the implementation of structured and actuarial risk assessments in practice.

        • Andrews, D. A., and J. Bonta. 2010. The psychology of criminal conduct. 5th ed. Newark, NJ: LexisNexis-Matthew Bender.

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          Within a framework of the risk-need-responsivity (RNR) model, this book discusses many issues relevant to risk assessment, including the validity and utility of actuarial assessments in terms of theory and empirical data. Actuarial assessments are discussed as a predecessor of the RNR model.

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        • Dawes, R. M., D. Faust, and P. E. Meehl. 1989. Clinical versus actuarial judgment. Science 243:1668–1674.

          DOI: 10.1126/science.2648573Save Citation »Export Citation »E-mail Citation »

          This article contrasts actuarial and clinical approaches. A strong empirical focus is taken, which supports the use of actuarial methods. Subsequently, reasons for the superiority of actuarial methods are discussed. However, the authors note that even though the empirical research supports actuarial methods, professionals are not using them.

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        • Garb, H. 2003. Clinical judgment and mechanical prediction. In Handbook of psychology. Vol. 10. Edited by I. Weiner, 27–42. Hoboken, NJ: Wiley.

          DOI: 10.1002/0471264385Save Citation »Export Citation »E-mail Citation »

          Contrasts actuarial and clinical prediction in a broader assessment context rather than in one specific to risk assessment. Specific factors that improve and worsen each approach are discussed in addition to detailed empirical research. Recommendations for improving assessments are made.

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        • Grove, W. M., and P. E. Meehl. 1996. Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: The clinical-statistical controversy. Psychology, Public Policy, and Law 2:293–323.

          DOI: 10.1037/1076-8971.2.2.293Save Citation »Export Citation »E-mail Citation »

          Empirical research contrasting clinical and actuarial methods is examined. The authors refute common objections to the use of actuarial assessments.

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        • Hannah-Moffat, K., P. Maurutto, and S. Turnbull. 2009. Negotiated risk: Actuarial illusions and discretion in probation. Canadian Journal of Law and Society 24.3: 391–409.

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          The authors discuss the implementation of actuarial and structured risk assessments in practice using interviews with correctional workers. Several issues are highlighted, including the role of discretion in the risk assessment process, gender and ethnicity issues, and problems with actuarial assessments.

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        • Heilbrun, K., K. Yasuhara, and S. Shah. 2010. Violence risk assessment tools: Overview and critical analysis. In Handbook of violence risk assessment. Edited by R. K. Otto and K. S. Douglas, 1–17. New York: Routledge.

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          This chapter introduces three general approaches to assessment (actuarial, structured professional judgment, and anamnestic). An in-depth analysis of each approach, including updated empirical research, is conducted. The comparison of these approaches is discussed specifically within the modern risk assessment field. The authors conclude that support exists for both actuarial and structured professional judgment approaches.

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        • Meehl, P. E. 1954. Clinical versus statistical prediction: A theoretical analysis and a review of the evidence. Minneapolis: Univ. of Minnesota Press.

          DOI: 10.1037/11281-000Save Citation »Export Citation »E-mail Citation »

          One of the first works to examine the clinical versus actuarial debate. The merits of each approach are discussed and the research to date is presented, leading the author to support the use of actuarial methods. This book should serve as the starting point for anyone interested in the overarching clinical-actuarial debate.

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        • Quinsey, V. L., G. T. Harris, M. E. Rice, and C. A. Cormier. 2006. Violent offenders: Appraising and managing risk. 2d ed. Washington, DC: American Psychological Association.

          DOI: 10.1037/11367-000Save Citation »Export Citation »E-mail Citation »

          Provides an extensive review of research and theory on violence prediction. A description of the development of an actuarial instrument is provided and numerous criticisms of the use of actuarial methods are contested.

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        Structured Professional Judgment

        The debate surrounding the clinical and actuarial approaches led to the emergence of the structured professional judgment (SPJ) model that sets out guidelines that reflect current empirical, theoretical, and clinical knowledge. The guidelines and procedures set out the necessary qualifications for assessors, the relevant information that should be considered, the manner in which information should be ascertained, effective communication strategies, and methods for implementing intervention strategies, as seen in Douglas, et al. 1999. Furthermore, this approach was developed in an effort to maintain the strengths of both actuarial and clinical approaches to prediction while minimizing their weaknesses (see Heilbrun, et al. 2009 and Doyle and Dolan 2002). Structure is imposed in the decision-making process by including a set number of factors that must be considered as well as including specific coding rules for each factor and explicit instructions for the determination of final decisions about risk, as discussed in Douglas and Reeves 2010. This structured approach has allowed the SPJ model to maintain both the transparency in the decision making process as well as the excellent empirical basis of the actuarial approach, as seen in Hart 2001. At the same time, the SPJ model incorporates the individualized nature of the clinical approach and it serves to link risk assessment and management strategies (see Heilbrun, et al. 2009).

        • Douglas, K. S., D. N. Cox, and C. D. Webster. 1999. Violence risk assessment: Science and practice. Legal and Criminological Psychology 4.2: 149–184.

          DOI: 10.1348/135532599167824Save Citation »Export Citation »E-mail Citation »

          Grounding their work in the framework of the scientist-practitioner model, the authors contrast the clinical and actuarial risk assessment methods. This framework is subsequently used to describe the emerging structured professional judgment model of risk assessment as an empirically validated assessment technique. Several instruments under this category are reviewed.

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        • Douglas, K. S., and K. Reeves. 2010. The HCR-20 violence risk assessment scheme: Overview and review of the research. In Handbook of violence risk assessment. Edited by R. K. Otto and K. S. Douglas, 147–185. New York: Routledge.

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          Provides theoretical background on the emergence of the SPJ model out of the clinical-actuarial debate. Also, provides an overview of the research comparing the SPJ model to other approaches, concluding that the SPJ model performs as well as or better than actuarial prediction. Describes in detail numerous aspects of a specific instrument under this model.

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        • Doyle, M., and M. Dolan. 2002. Violence risk assessment: Combining actuarial and clinical information to structure clinical judgments for the formulation and management of risk. Journal of Psychiatric and Mental Health Nursing 9.6: 649–657.

          DOI: 10.1046/j.1365-2850.2002.00535.xSave Citation »Export Citation »E-mail Citation »

          Discusses the structured professional judgment approach as emerging out of unstructured clinical and actuarial assessments within Monahan’s generational paradigm. Places the discussion in an applied and clinical framework, highlighting the importance of “risk formulation.”

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        • Hart, S. D. 2001. Assessing and managing violence risk. In HCR-20 violence risk management companion guide. Edited by K. S. Douglas, C. D. Webster, S. D. Hart, D. Eaves, and J. R. P. Ogloff, 13–25. Burnaby, BC: Mental Health, Law, & Policy Institute, Simon Fraser Univ.

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          Describes and critiques several types of assessment procedures, including clinical prediction, anamnestic assessment, actuarial prediction, and structured professional judgment. Mentions common limitations to all assessment methods and provides directions for choosing which method to use in certain situations.

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        • Heilbrun, K., K. S. Douglas, and K. Yasuhara. 2009. Violence risk assessment: Core controversies. In Psychological science in the courtroom: Consensus and controversy. Edited by J. L. Skeem, K. S. Douglas, and S. O. Lilienfeld, 333–357. New York: Guilford.

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          Reviews both theoretical and empirical aspects of the clinical-actuarial debate and how the SPJ model was developed out of these two methods. Also highlights the importance of the individualistic nature of assessments and the use of group-based data in these decisions. Several myths and misconceptions are reviewed.

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        Meta- and Quasi-Meta-Analytic Research

        For decades, researchers and professionals have sought to determine the type of assessment that best predicts behavior. Numerous studies and meta-analyses have investigated the aforementioned clinical versus actuarial debate. Historically, actuarial methods have been shown to outperform unstructured clinical approaches to prediction, as seen in Mossman 1994. Many of these studies examined the prediction of any behavior of interest (for example, Ægisdótter, et al. 2006), not restricting the prediction to a specific target behavior. Meta-analyses that examined the prediction of a diverse array of behaviors have found that actuarial methods generally outperform other assessment approaches, as seen in Ægisdótter, et al. 2006 and Grove, et al. 2000. When the behavior examined was restricted to violence or recidivism, the results have been much less clear. Mossman 1994 concludes that actuarial methods are superior to clinical judgment when predicting violence. More recent studies have come to different conclusions. Hanson and Morton-Bourgon 2009 concludes that actuarial assessment yields the best predictive accuracy, followed by structured professional judgment instruments and then unstructured clinical judgment. In contrast, Guy 2008 finds that actuarial and SPJ instruments yield comparable predictive accuracy rates for predicting violence and general recidivism. This finding is consistent with that found in Yang, et al. 2010. When comparing commonly used risk assessment instruments, these authors find essentially no differences in the predictive accuracy of the different tools. Although many studies have come to the conclusion that actuarial prediction is superior to all other approaches, this statement seems to depend on what is being predicted and on how recent the analysis has been undertaken.

        • Ægisdótter, S., M. J. White, P. M. Spengler, et al. 2006. The meta-analysis of clinical judgment project: Fifty-six years of accumulated research on clinical versus statistical prediction. The Counseling Psychologist 34: 341–382.

          DOI: 10.1177/0011000005285875Save Citation »Export Citation »E-mail Citation »

          Subsequent to an in-depth review of the clinical-actuarial debate, this meta-analysis examined sixty-seven studies in which a direct comparison was made between a clinician’s prediction and a statistical, or actuarial, prediction in any respect. Overall, the data suggest that actuarial methods are marginally but consistently superior to clinical prediction.

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        • Grove, W. M., D. H. Zald, B. S. Lebow, B. E. Snitz, and C. Nelson. 2000. Clinical versus mechanical prediction: A meta-analysis. Psychological Assessment 12.1: 19–30.

          DOI: 10.1037/1040-3590.12.1.19Save Citation »Export Citation »E-mail Citation »

          This meta-analysis examined 136 studies in which both professional and actuarial procedures made judgments regarding human health and behavior. Any assessments in the psychological or medical field were included. Overall, actuarial methods were found to be superior in about 50 percent of studies, even after controlling for several factors.

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        • Guy, L. S. 2008. Performance indicators of the structured professional judgement approach for assessing risk for violence to others: A meta-analytic survey. PhD diss., Simon Fraser Univ.

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          This unpublished doctoral dissertation examined the performance of the structured professional judgment model compared to other approaches to violence risk assessment. Using 113 disseminations, the author concludes that SPJ instruments perform at essentially equal levels to actuarial tools.

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        • Hanson, R. K., and K. E. Morton-Bourgon. 2009. The accuracy of recidivism risk assessments for sexual offenders: A meta-analysis of 118 prediction studies. Psychological Assessment 21:1–21.

          DOI: 10.1037/a0014421Save Citation »Export Citation »E-mail Citation »

          Examined 118 samples and 536 effect sizes regarding the recidivism of sexual offenders. Regarding the prediction of violence, sexual violence, and any recidivism, actuarial methods performed best, followed by structured professional judgment measures and finally unstructured clinical judgment.

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        • Mossman, D. 1994. Assessing predictions about violence: Being accurate about accuracy. Journal of Consulting and Clinical Psychology 62.4: 783–792.

          DOI: 10.1037/0022-006X.62.4.783Save Citation »Export Citation »E-mail Citation »

          Examining forty-four studies of violence prediction, the author finds that actuarial methods, especially those that are cross validated, outperform clinical judgment.

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        • Yang, M., S. C. P. Wong, and J. Coid. 2010. The efficacy of violence prediction: A meta-analytic comparison of nine risk assessment tools. Psychological Bulletin 136.5: 740–767.

          DOI: 10.1037/a0020473Save Citation »Export Citation »E-mail Citation »

          The authors investigated the predictive validity of nine commonly used violence risk assessment tools that fall under the various assessment approaches. Based on twenty-eight samples, it was found that the tools essentially perform equally and, thus, are interchangeable in their use based solely on predictive accuracy.

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        Direct Comparative Research

        Several studies have directly examined the various assessment approaches, including SPJ and actuarial instruments as well as unstructured clinical judgment in attempts to clarify the utility of these tools for predicting violence and recidivism. These studies have used diverse samples, including children (Enebrink, et al. 2006), adolescents (Catchpole and Gretton 2003), adults (Douglas, et al. 2005), forensic psychiatric patients (de Vogel, et al. 2004a), sex offenders (de Vogel, et al. 2004b), and general offenders (Douglas, et al. 2005). Multiple study designs were also used, including retrospective (de Vogel, et al. 2004a), quasi-prospective (Douglas, et al. 2003), and truly prospective (Enebrink, et al. 2006). Studies also differed in numerous additional aspects, including the country where the research was conducted, the follow-up length, and the inclusion of different assessment instruments. Overall, the studies found either that SPJ and actuarial assessment approaches yielded equal predictive accuracy, as seen in Catchpole and Gretton 2003, or that judgments based on SPJ instruments outperform other assessment approaches, as seen in de Vogel and de Ruiter 2005; de Vogel, et al. 2004a; de Vogel, et al. 2004b; Douglas, et al. 2003; Douglas, et al. 2005; and Enebrink, et al. 2006.

        • Catchpole, R. E. H., and H. M. Gretton. 2003. The predictive validity of risk assessment with violent young offenders: A 1-year examination of criminal outcome. Criminal Justice and Behavior 30:688–708.

          DOI: 10.1177/0093854803256455Save Citation »Export Citation »E-mail Citation »

          Examines the predictive validity of three assessment instruments designed for use with adolescents. Using a quasi-prospective design and scoring the instruments based on file information alone, the authors found that the three instruments (one SPJ and two actuarial) equally predict violent and general recidivism.

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        • de Vogel, V., and C. de Ruiter. 2005. The HCR-20 in personality disordered female offenders: A comparison with a matched sample of males. Clinical Psychology & Psychotherapy 12.3: 226–240.

          DOI: 10.1002/cpp.452Save Citation »Export Citation »E-mail Citation »

          The authors examined the use of the HCR-20 and the PCL-R across both genders in Dutch forensic psychiatric samples. In males, the HCR-20 and the PCL-R were found to predict violence, whereas in females only the final risk judgment made using the HCR-20 were predictive of violence.

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        • de Vogel, V., C. de Ruiter, M. Hildebrand, B. Bos, and P. van de Ven. 2004a. Type of discharge and risk of recidivism measured by the HCR-20: A retrospective study in a Dutch sample of treated forensic psychiatric patients. International Journal of Forensic Mental Health 3:149–165.

          DOI: 10.1080/14999013.2004.10471204Save Citation »Export Citation »E-mail Citation »

          The authors investigated the predictive validity of the Historical-Clinical-Risk Management-20 (HCR-20), PCL-R, and unstructured clinical judgment in a sample of 120 forensic psychiatric patients. Regarding the prediction of violent recidivism, they found that the HCR-20 outperformed both unstructured clinical judgment and the PCL-R.

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        • de Vogel, V., C. de Ruiter, D. van Beek, and G. Mead. 2004b. Predictive validity of the SVR-20 and Static-99 in a Dutch sample of treated sex offenders. Law & Human Behavior 28.3: 235–251.

          DOI: 10.1023/B:LAHU.0000029137.41974.ebSave Citation »Export Citation »E-mail Citation »

          The authors studied the use of the SVR-20 (an SPJ instrument) and the Static-99 (an actuarial instrument). They found that both instruments were predictive of reconvictions in the sex offender sample, but that the final risk judgments made using the SVR-20 were a better predictor than the Static-99.

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        • Douglas, K. S., J. R. P. Ogloff, and S. D. Hart. 2003. Evaluation of a model of violence risk assessment among forensic psychiatric patients. Psychiatric Services 54.10: 1372–1379.

          DOI: 10.1176/appi.ps.54.10.1372Save Citation »Export Citation »E-mail Citation »

          The authors found that the HCR-20 was predictive of community violence in a sample of forensic psychiatric patients. Furthermore, the final risk judgments added incrementally to other factors used actuarially.

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        • Douglas, K. S., M. Yeomans, and D. P. Boer. 2005. Comparative validity analysis of multiple measures of violence risk in a sample of criminal offenders. Criminal Justice and Behavior 32.5: 479–510.

          DOI: 10.1177/0093854805278411Save Citation »Export Citation »E-mail Citation »

          The authors investigated the predictive accuracy of SPJ and actuarial instruments using a sample of 188 general offenders. They found that many of the instruments were related to violence, but that the HCR-20, and in particular the final risk judgments it supports, was more consistently related to violence than the other instruments.

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        • Enebrink, P., N. Langstrom, and C. H. Gumpert. 2006. Predicting aggressive and disruptive behavior in referred 6- to 12-year-old boys: Predictive validation of the EARL-20B risk/needs checklist. Assessment 13.3: 356–367.

          DOI: 10.1177/1073191106290649Save Citation »Export Citation »E-mail Citation »

          The authors evaluated the use of an SPJ instrument designed for use with male children (ages six to twelve). They found that the instrument was more strongly related to the outcome than unstructured clinical judgment or other factors.

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        Type of Outcome

        Many risk assessment instruments are available to choose from; however, what the outcome is will determine what should be used. A good edited book with an overview of these tools is Otto and Douglas 2010. Chapters are written by authors of the measures. There are tools for youth and adults. Childhood risk assessment tools include the Early Assessment Risk List for Girls, Version 1 (EARL-21G; see pp. 43–62 in Otto and Douglas 2010) and the Early Assessment Risk List for Boys, Version 2 (EARL-20B; see pp. 43–62 in Otto and Douglas 2010). The Structured Assessment of Violence Risk in Youth (SAVRY; see pp. 63–79 in Otto and Douglas 2010) is used with adolescents to determine violence risk. An actuarial tool to assess for violence recidivism risk in men is the Violence Risk Appraisal Guide (VRAG; see pp. 99–119 in Otto and Douglas 2010). The Sex Offender Risk Appraisal Guide (SORAG; see pp. 99–119 in Otto and Douglas 2010) came out of the VRAG. Another tool for violent recidivism is the Ontario Domestic Assault Risk Assessment (ODARA; see pp. 99–119 in Otto and Douglas 2010), but it is meant to be used specifically for domestic violence against a female partner. For general violence risk among adults, the Historical-Clinical-Risk Management-20 (HCR-20; see pp. 147–185 in Otto and Douglas 2010) is available. An actuarial tool to assess for violence risk in individuals with a mental disorder is the Classification of Violence Risk (COVR; see pp. 187–198 in Otto and Douglas 2010). A tool that is used to assess for offender risk and needs is the Level of Service/Case Management Inventory (LS/CMI; see pp. 199–225 in Otto and Douglas 2010); the youth equivalent to this measure is the Youth Level of Service/Case Management Inventory (YLS/CMI; see pp. 81–95 in Otto and Douglas 2010). Risk for spousal assault can be assessed with the Spousal Assault Risk Assessment Guide (SARA; see pp. 227–250 in Otto and Douglas 2010). The Static-99 (see pp. 251–267 in Otto and Douglas 2010) came out of the Rapid Risk Assessment for Sexual Offense Recidivism (RRASOR; see pp. 251–267 in Otto and Douglas 2010) and is an actuarial instrument for sexual recidivism. Structured professional judgment instruments for the assessment of sexual violence risk include the Sexual Violence Risk-20 (SVR-20; see pp. 269–294 in Otto and Douglas 2010) and the Risk for Sexual Violence Protocol (RSVP; see pp. 269–294 in Otto and Douglas 2010).

        • Otto, R. K., and K. S. Douglas. 2010. Handbook of violence risk assessment. New York: Routledge.

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          This book constitutes an excellent overview of the different assessment tools listed in this section. For each instrument, it provides a description of the instrument, contexts for which it is appropriate, how it was developed, how it should be used, summaries of validity and reliability data, and a sample assessment report.

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        Types of Risk Factors

        The various ways risk factors can be described are outlined in the subsections. First, protective factors are discussed. Second, work on dynamic and static risk factors is explored. Finally, a review of other well-supported risk factors is provided.

        Risk versus Protective Factors

        Some researchers have argued that too much emphasis is placed on risk factors and not enough on protective factors, such as Rogers 2000. Although much less research has been done on protective factors compared to risk factors, the former should be a focus since they are consistent with the idea that risk assessment should be preventative. Several tools that incorporate protective factors are available. The Short-Term Assessment of Risk and Treatability (START; see Webster, et al. 2006) includes both risk and protective factors. One instrument is made up solely of protective factors—the Structured Assessment of Protective Factors for violence risk (SAPROF; see de Vogel, et al. 2011). There are also youth measures that take protective factors into account, according to Rennie and Dolan 2010.

        • de Vogel, V., M. de Vries Robbé, C. de Ruiter, and Y. H. A. Bouman. 2011. Assessing protective factors in forensic psychiatric practice: Introducing the SAPROF. International Journal of Forensic Mental Health 10.3: 171–177.

          DOI: 10.1080/14999013.2011.600230Save Citation »Export Citation »E-mail Citation »

          The authors describe the Structured Assessment of Protective Factors for violence risk (SAPROF), a structured professional judgment (SPJ) tool that contains solely protective factors (e.g., empathy and life goals).

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        • Rennie, C. E., and M. C. Dolan. 2010. The significance of protective factors in the assessment of risk. Criminal Behaviour and Mental Health 20.1: 8–22.

          DOI: 10.1002/cbm.750Save Citation »Export Citation »E-mail Citation »

          This study evaluated protective factors in youth using the Structured Assessment of Violence Risk in Youth (SAVRY). A message to take away is that protective factors should be considered since they have support in that they may reduce the effects of risk factors.

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        • Rogers, R. 2000. The uncritical acceptance of risk assessment in forensic practice. Law and Human Behavior 24.5: 595–605.

          DOI: 10.1023/A:1005575113507Save Citation »Export Citation »E-mail Citation »

          Rogers argues that concentrating only on risk factors weakens assessment. This article provides support for incorporating protective factors in risk assessment.

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        • Webster, C. D., T. L. Nicholls, M. L. Martin, S. L. Desmarais, and J. Brink. 2006. Short-term assessment of risk and treatability (START): The case for a new violence risk structured professional judgment scheme. Behavioral Sciences and the Law 24.6: 747–766.

          DOI: 10.1002/bsl.737Save Citation »Export Citation »E-mail Citation »

          This article describes the START, an SPJ tool on which evaluators rate each factor according to whether it is a vulnerability and/or a strength for the person. The authors of the START opine that any given factor can have elements that might put a person at risk or act as a strength or protective factor.

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        Dynamic versus Static Factors

        Risk factors should be predictive. Static risk factors are unchangeable, as the name implies, whereas dynamic factors are not static and can be changed, as discussed in Wong, et al. 2009; Bonta 2002; and Hanson 1998. Dynamic risk factors can be split up into two groups: stable and acute (see Hanson 1998 and Douglas and Skeem 2005). Actuarial risk approaches have tended to rely primarily on static factors or dynamic factors defined in a static manner, whereas SPJ tools include both static and dynamic factors.

        • Bonta, J. 2002. Offender risk assessment: Guidelines for selection and use. Criminal Justice and Behavior 29:355–379.

          DOI: 10.1177/0093854802029004002Save Citation »Export Citation »E-mail Citation »

          Guidelines for risk assessment are provided. One of the guidelines goes into depth about dynamic risk factors and how they are important.

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        • Douglas, K. S., and J. L. Skeem. 2005. Violence risk assessment: Getting specific about being dynamic. Psychology, Public Policy, and Law 11.3: 347–383.

          DOI: 10.1037/1076-8971.11.3.347Save Citation »Export Citation »E-mail Citation »

          This article is a good read for individuals wanting to learn about dynamic risk factors and the current research on the topic. It provides a review of risk factors that have empirical evidence both in terms of their association with violence and in terms of their dynamic nature.

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        • Hanson, R. K. 1998. What do we know about sexual offender risk assessment? Psychology, Public Policy, and Law 4:50–72.

          DOI: 10.1037/1076-8971.4.1-2.50Save Citation »Export Citation »E-mail Citation »

          This article provides a glimpse into the state of research on sex offender assessment. The author gives a good explanation of the difference between static and dynamic factors. Further, the author explains that dynamic factors need to be considered in risk assessment of sex offenders.

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        • Wong, S. P., M. E. Olver, and K. C. Stockdale. 2009. The utility of dynamic and static factors in risk assessment, prediction, and treatment. In Handbook of violence risk assessment and treatment: New approaches for mental health professionals. Edited by J. T. Andrade, 83–120. New York: Springer.

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          Dynamic and static risks are described and discussed throughout this chapter. Dynamic and static factors in terms of instruments are explored. Included are sections on risk assessment of sexual offenders and young offenders.

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        Important Risk Factors

        Research on risk factors is abundant. This section reviews articles on risk factors that Andrews and Bonta called the central eight and the big four. Other well-researched risk factors can be separated into different categories and are also explored.

        Central Eight and Big Four

        Andrews and Bonta are responsible for the convention of naming certain risk factors that have received consistent support in the literature as the “central eight” and the “big four.” According to Bonta 2011 and Andrews, et al. 2006, these factors are part of the risk-need-responsivity model, and they are as follows: history of antisocial behavior, antisocial personality pattern, antisocial cognition, antisocial associates, family and/or marital, school and/or work, leisure and/or recreation, and substance abuse. The big four part of the central eight are history of antisocial behavior, antisocial personality pattern, antisocial cognition, and antisocial associates. Andrews, et al. 2006 states that these factors are criminogenic need factors, also called dynamic risk factors. Bonta 2011 stated that targeting criminogenic need factors should reduce the likelihood of recidivism.

        • Andrews, D. A., J. Bonta, and J. S. Wormith. 2006. The recent past and near future of risk and/or need assessment. Crime & Delinquency 52:7–27.

          DOI: 10.1177/0011128705281756Save Citation »Export Citation »E-mail Citation »

          The central eight and the big four are laid out in a table that not only describes them, but also provides solutions to target each respective risk factor. Additionally, different approaches from different generations of risk assessment are reviewed.

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        • Bonta, J. March. 2011. The risk-need-responsivity model: From what works to making it work. Paper presented at the 7th Annual Pacific Forensic Psychiatry Conference, Vancouver, British Columbia, Canada.

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          This conference presentation explored rehabilitation by discussing the risk-need-responsivity model. The central eight and the big four are outlined in an easy-to-understand table. The take-home message is that when the RNR model, which includes the central eight and the big four, was followed, rates of recidivism were reduced.

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        Other Well-Supported Risk Factors

        General risk factor categories have found support through research. Nikolova, et al. 2009 proposes that there are personal, historical, contextual, and clinical risk factors. Otto 2000 has similar groupings of risk factors, namely demographic, historical, clinical, and contextual. Some researchers argue that emphasis is given to individual risk factors and that situational risk factors should also be considered, including Cooke, et al. 2008.

        • Cooke, D. J., E. Wozniak, and L. Johnstone. 2008. Casting light on prison violence in Scotland: Evaluating the impact of situational risk factors. Criminal Justice and Behavior 35.8: 1065–1078.

          DOI: 10.1177/0093854808318867Save Citation »Export Citation »E-mail Citation »

          Situational factors, specifically relating to institutional violence, are discussed in this article. The authors propose a way to systematically assess for situational risk factors (PRISM, or promoting risk intervention by situational management).

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        • Nikolova, N., D. S. Strub, and K. S. Douglas. 2009. Violence risk assessment. In Encyclopedia of forensic science. Edited by C. Edwards. Hoboken, NJ: Wiley.

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          Different types of risk factors are described. Personal (e.g., personality traits), historical (e.g., past events), contextual (e.g., environmental factors), and clinical (e.g., substance abuse) are the categories under which the various risk factors are organized.

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        • Otto, R. K. 2000. Assessing and managing violence risk in outpatient settings. Journal of Clinical Psychology 56.10: 1239–1262.

          DOI: 10.1002/1097-4679(200010)56:10%3C1239::AID-JCLP2%3E3.0.CO;2-JSave Citation »Export Citation »E-mail Citation »

          A good overview of risk assessment is provided in this article. The article has a section devoted to risk factors. The categories of risk factors include demographic (e.g., gender), historical (e.g., history of violence), clinical (e.g., substance abuse), and contextual (e.g., unemployment).

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        Gender and Ethnicity

        Gender and ethnicity are important factors to take into consideration when conducting risk assessments or evaluating risk assessment instruments. Risk factors might be present in differing proportions across genders or ethnicities or they might relate to violence with differential strength across such groups. For instance, Singh, et al. 2011 examines sixty-eight risk assessment studies and also includes an analysis of whether gender and ethnicity impacted the strength of prediction. Generally, gender did not, whereas some evidence is found that ethnicity did impact accuracy. As for gender specifically, Coid, et al. 2009 examines five risk assessment instruments and reports that some indices were more strongly related to violence for one gender compared to the other. Garcia-Mansilla, et al. 2009 discusses whether women commit violence for different reasons than men, and whether their risk factors differ in how often they are present. Manchak, et al. 2009 explores the impact of gender on the LSI-R specifically. Although gender did not influence predictive accuracy, certain risk factors were more strongly related to violence for one gender or the other. Thompson and McGrath 2011 is based on a study among adolescent offenders, and the authors report that although the prevalence of certain LSI-R risk factors might differ across genders and ethnicities, the predictive accuracy of the risk factors do not. For forensic psychiatric patients, Strand and Belfrage 2001 finds that men and women may have risk factors that are similar; however, the nature of the violence might differ.

        • Coid, J., M. Yang, S. Ullrich, et al. 2009. Gender differences in structured risk assessment: Comparing the accuracy of five instruments. Journal of Consulting and Clinical Psychology 77.2: 337–348.

          DOI: 10.1037/a0015155Save Citation »Export Citation »E-mail Citation »

          In a sample of 1,353 male and female offenders, the authors examined whether gender affected predictive validity for five commonly used risk assessment tools. There was some evidence that certain scales performed better for one gender or the other, depending in part on the nature of violence under consideration.

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        • Garcia-Mansilla, A., B. Rosenfeld, and T. L. Nicholls. 2009. Risk assessment: Are current methods applicable to women? International Journal of Forensic Mental Health 8.1: 50–61.

          DOI: 10.1080/14999010903014747Save Citation »Export Citation »E-mail Citation »

          This article examines gender within the context of violence risk and psychopathy. The authors reviewed numerous studies, and they found that unstructured clinical judgments were inadequate for women. They conclude that for structured methods (actuarial or structured professional judgment), some studies support their use with women whereas others do not. They affirm that more research is needed in this area.

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        • Manchak, S. M., J. L. Skeem, K. S. Douglas, and M. Siranosian. 2009. Does gender moderate the predictive utility of the level of service inventory—revised (LSI-R) for serious violent offenders? Criminal Justice and Behavior 36.5: 425–442.

          DOI: 10.1177/0093854809333058Save Citation »Export Citation »E-mail Citation »

          The authors of this article examined gender and the LSI-R among 1,105 offenders. The authors discussed a finding that whereas gender did not moderate the predictive accuracy of the LSI-R, different risk factors impacted recidivism for men and women.

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        • Singh, J. P., M. Grann, and S. Fazel. 2011. A comparative study of violence risk assessment tools: A systematic review and metaregression analysis of 68 studies involving 25,980 participants. Clinical Psychology Review 31.3: 499–513.

          DOI: 10.1016/j.cpr.2010.11.009Save Citation »Export Citation »E-mail Citation »

          In this meta-analytic analysis of sixty-eight studies, the authors evaluated whether gender and ethnicity influenced the strength with which risk assessment instruments were related to violence. The authors found that gender tended not to moderate predictive accuracy. Instruments tended to perform less well in samples with a greater degree of individuals who were not members of minorities, although not to a large degree.

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        • Strand, S., and H. Belfrage. 2001. Comparison of HCR-20 scores in violent mentally disordered men and women: Gender differences and similarities. Psychology, Crime and Law 7.1: 71–79.

          DOI: 10.1080/10683160108401784Save Citation »Export Citation »E-mail Citation »

          The authors found that the presence of risk factors identified by the HCR-20 for eighty-five male and sixty-three female forensic psychiatric patients were comparable in that few differed between men and women. However, the violence itself differed in that women were more likely to be violent and their violence was more often directed at staff than patients, whereas the converse was true for men.

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        • Thompson, A. P., and A. McGrath. 2012. Subgroup differences and implications for contemporary risk-need assessment with juvenile offenders. Law and Human Behavior 36(4): 345–355.

          DOI: 10.1037/h0093930Save Citation »Export Citation »E-mail Citation »

          This study of 3,568 juvenile offenders indicated certain risk factors differed in frequency as a function of ethnicity and gender. Importantly, however, validity indices did not differ.

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        Professional Use and Ethical Issues

        The professional or clinical use of risk assessment instruments is a task with serious consequences. Numerous important professional and ethical issues must be considered. These issues include considerations of how to professionally, and ethically, develop, validate, and select an assessment instrument as well as how to conduct an assessment, communicate the results, and most generally comport oneself in a professional manner. In providing a general overview, Heilbrun 2001 discusses principles relevant to all individuals working in a forensic mental health field. Ogloff and Douglas 2003 discusses this matter in a slightly narrower context. This chapter presents various ethical and professional issues relevant to forensic psychologists, including regulations and ethical guidelines set forth by regulatory bodies of this professional group. As individuals belonging to various professional affiliations conduct risk assessments, each professional must be familiar with the ethics of their governing or regulatory bodies. More specific to the risk assessment field, Otto and Douglas 2010 contains chapters that focus on particular risk assessment instruments. Guidelines for the use of different instruments are discussed in each of the chapters. Focusing on a particular risk assessment instrument, the HCR-20, Webster, et al. 2002 discusses several requirements and guidelines for the selection and use of assessment tools as well as for training professionals. Bonta 2002 and Borum 1996 each provide guidelines and recommendations for the ethical selection and use of assessment instruments as well as additional standards for training professionals and guidelines concerning the manner in which professionals should conduct themselves in clinical settings. Finally, Douglas and Kropp 2002 focuses on the standards and ethics involved in development and validation of risk assessment instruments, including ethical issues that arise in conducting research regarding risk assessment instruments.

        • Bonta, J. 2002. Offender risk assessment: Guidelines for selection and use. Criminal Justice and Behavior 29:355–379.

          DOI: 10.1177/0093854802029004002Save Citation »Export Citation »E-mail Citation »

          Provides ten guidelines and recommendations for the selection and ethical use of risk assessment instruments, focusing on general offender assessment. The guidelines range from specific criteria that instruments should meet to be used professionally to broad generalizations about the comportment of professionals in the field.

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        • Borum, R. 1996. Improving the clinical practice of violence risk assessment: Technology, guidelines, and training. American Psychologist 51.9: 945–956.

          DOI: 10.1037/0003-066X.51.9.945Save Citation »Export Citation »E-mail Citation »

          In addition to reviewing significant developments in risk assessment, this article provides three overall recommendations for improving the risk assessment field: improving the risk assessment instruments, establishing clear guidelines for clinical practice, and establishing training programs.

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        • Douglas, K. S., and P. R. Kropp. 2002. A prevention-based paradigm for violence risk assessment: Clinical and research applications. Criminal Justice and Behavior 29.5: 617–658.

          DOI: 10.1177/009385402236735Save Citation »Export Citation »E-mail Citation »

          This article discusses at length a model for comprehensively and effectively validating risk assessment instruments in order that the instruments can be used in an ethical and professional manner. Furthermore, ethical concerns relevant to the validation of, and research using, risk assessment instruments are discussed.

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        • Heilbrun, K. 2001. Principles of forensic mental health assessment. New York: Kluwer.

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          This book discusses at length principles and guidelines for professional and effective practice as a professional conducting assessment in forensic contexts. This book is relevant to a broader audience beyond risk assessment professionals.

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        • Ogloff, J. R. P., and K. S. Douglas. 2003. Psychological assessment in forensic settings. In Handbook of psychology. Vol. 10. Edited by I. Weiner, 345–363. Hoboken, NJ: Wiley.

          DOI: 10.1002/0471264385Save Citation »Export Citation »E-mail Citation »

          Discusses numerous guidelines set forth by regulatory bodies for clinical psychologists. Also discusses additional requirements for professional competence in the area of forensic psychology.

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        • Otto, R. K., and K. S. Douglas. 2010. Handbook of violence risk assessment. New York: Routledge.

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          Each chapter in the book is dedicated to a different risk assessment instrument or class of instruments. Included in each chapter are guidelines for the use of that instrument and issues or concerns that are relevant to the use of that instrument are considered.

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        • Webster, C. D., R. Müller-Isberner, and G. Fransson. 2002. Violence risk assessment: Using structured clinical guides professionally. International Journal of Forensic Mental Health 1.2: 185–193.

          DOI: 10.1080/14999013.2002.10471173Save Citation »Export Citation »E-mail Citation »

          Using the HCR-20 as an example, the authors mention several stages of risk assessment development. As well, they propose several requirements that developers of risk assessment instruments should strive to meet, including the development of standards for administration, reporting, and training.

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        Risk Management

        The relationship between risk assessment and risk management has not been incontrovertibly settled. Two distinct opinions still exist, as seen in Skeem and Monahan 2011. Some professionals posit that risk assessment and risk management should be treated as completely separate stages that need not rely on one another. This position is taken in Monahan and Steadman 1994. In contrast, others posit that risk assessment and risk management should be treated as a single process with the ultimate goal of reducing or preventing future violence and crime. Skeem and Monahan 2011 discusses the distinction between the two views and details circumstances in which each view may be appropriate. In contrast, Douglas and Kropp 2002 emphasizes that risk assessment should be rooted in a prevention-based framework. Similarly, Andrews and Bonta 2010 discusses the risk-need-responsivity model. Within this model, assessment and management are both considered, on the grounds that assessment leads directly into management and intervention strategies. Lewis and Doyle 2009 takes a similar stance in considering risk assessment and management as parts of a single overall process. The authors discuss this link in terms of “risk formulation” that involves both of the stages. The literature on specific management and intervention strategies for reducing violence and crime is still limited. However, Hart 2008 discusses guiding principles for management strategies. Both Hart 2008 and Otto 2000 discuss specific categories of management strategies, including but not limited to monitoring, incapacitation, and victim safety planning. More specifically, Douglas, et al. 2009 focuses on management strategies within a specific population, namely those with serious mental illnesses. These works review the major management approaches available to professionals and highlight relevant empirical research on the various strategies.

        • Andrews, D. A., and J. Bonta. 2010. Rehabilitating criminal justice policy and practice. Psychology, Public Policy, and Law 16.1: 39–55.

          DOI: 10.1037/a0018362Save Citation »Export Citation »E-mail Citation »

          Targets the risk-need-responsivity model to the assessment and management of offenders. Within this model, assessment and management are inseparable, as the model describes who should receive services, what factors should be targeted, and how the treatment should proceed. Empirical support for this model is also provided.

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        • Douglas, K. S., and P. R. Kropp. 2002. A prevention-based paradigm for violence risk assessment: Clinical and research applications. Criminal Justice and Behavior 29.5: 617–658.

          DOI: 10.1177/009385402236735Save Citation »Export Citation »E-mail Citation »

          This article emphasizes that risk assessment should be grounded within a prevention-based framework. Thus, the processes of risk assessment and risk management should be closely united as a single approach in attempts to prevent future violence from occurring. Important considerations from a prevention stance are discussed.

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        • Douglas, K. S., T. L. Nicholls, and J. Brink. 2009. Reducing the risk of violence among persons with mental illness: A critical analysis of treatment approaches. In Behavioral emergencies: An evidence-based resource for evaluating and managing risk of suicide, violence, and victimization. Edited by P. M. Kleespies, 351–376. Washington, DC: American Psychological Association.

          DOI: 10.1037/11865-000Save Citation »Export Citation »E-mail Citation »

          Focusing on the management of violence with individuals with serious mental illnesses, the authors discuss the major approaches that are available and review the empirical findings relevant to each approach. In concluding, some general recommendations are made for implementing and treatment of management strategies.

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        • Hart, S. D. 2008. Preventing violence: The role of risk assessment and management. In Intimate partner violence prevention and intervention. Edited by A. C. Baldry and F. W. Winkel, 7–18. Hauppauge, NY: Nova Science.

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          Discusses both risk assessment and management as separate but interconnected processes. Sets out guidelines for effective management strategies and highlights four fundamental categories of risk management.

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        • Lewis, G., and M. Doyle. 2009. Risk formulation: What are we doing and why? International Journal of Forensic Mental Health 8:286–292.

          DOI: 10.1080/14999011003635696Save Citation »Export Citation »E-mail Citation »

          Describes the overall process of risk assessment and management as “risk formulation.” A five-step model of risk formulation is discussed that includes the assessment, integration, communication, and management of risk.

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        • Monahan, J., and H. J. Steadman, eds. 1994. Violence and mental disorder: Developments in risk assessment. Chicago: Univ. of Chicago Press.

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          This book focuses almost exclusively on the risk assessment process as, in the opinion of the authors, risk assessment and risk management are separate processes.

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        • Otto, R. K. 2000. Assessing and managing violence risk in outpatient settings. Journal of Clinical Psychology 56:1239–1262.

          DOI: 10.1002/1097-4679(200010)56:10%3C1239::AID-JCLP2%3E3.0.CO;2-JSave Citation »Export Citation »E-mail Citation »

          This fundamental work describes general approaches to the intervention and treatment of factors associated with violence as well as providing a detailed discussion of management strategies specifically aimed at reducing and preventing violent behavior.

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        • Skeem, J. L., and J. Monahan. 2011. Current directions in violence risk assessment. Current Directions in Psychological Science 20.1: 38–42.

          DOI: 10.1177/0963721410397271Save Citation »Export Citation »E-mail Citation »

          Highlights the distinct views that (a) risk assessment and management are connected and should be one process versus (b) risk assessment and risk management can proceed as two distinct stages. The merits of each view are discussed.

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        Future Directions

        The bread-and-butter research on the validation of existing risk assessment instruments and the refinement of our understanding of risk factors must continue. In addition, several themes in risk assessment scholarship are emerging that have strong potential to move the field ahead in very meaningful ways. First, research on the reliability and validity of risk assessment instruments in actual clinical practice should continue as initial research suggests that even well-validated instruments may fare less well in the field than in the carefully controlled research studies, as seen in Murrie, et al. 2009. Second, research should investigate the factors that lead to structured professional judgments performing as well as, or better than, actuarial predictions, as discussed in Douglas and Reeves 2010. Third, scholars should continue the budding work on how to integrate clinical conceptualization and case formulation into risk assessment in order to understand causes of violence at the individual level, as discussed in Douglas, et al. 2013 and Hart and Logan 2011. Finally, continued efforts to link risk assessment to risk reduction and intervention efforts are necessary, as seen in Andrews 2012 and Wong and Olver 2010.

        • Andrews, D. A. 2012. The risk-need-responsivity (RNR) model of correctional assessment and treatment. In Using social science to reduce violent offending. Edited by J. A. Dvoskin, J. L. Skeem, R. W. Novaco, and K. S. Douglas, 127–156. New York: Oxford Univ. Press.

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          This chapter reviews the RNR model of correctional assessment and treatment. It discusses explicitly how this model links assessment to treatment in that (a) higher risk offenders must receive higher intensity supervision or intervention; (b) treatment must target dynamic risk factors that are identified through assessment; and (c) treatment must be delivered in a manner that corresponds best to offenders’ learning styles.

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        • Douglas, K. S., A. Blanchard, and M. C. Hendry. 2013. Violence risk assessment and management: Putting structured professional judgment into practice. In Managing Clinical Risk: A Guide to Effective Practice. Edited by C. Logan and L. Johnstone, 29–55. New York: Routledge.

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          This review focuses on how to use the structured professional judgment model of risk assessment in practice. It reviews how it can inform case formulation in order to discern the reasons why specific individuals might act violently. The chapter discusses several approaches to formulation that might be of use to practitioners and which are ripe for empirical evaluation.

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        • Douglas, K. S., and K. Reeves. 2010. The HCR-20 violence risk assessment scheme: Overview and review of the research. In Handbook of violence risk assessment. Edited by R. K. Otto and K. S. Douglas, 147–185. New York: Routledge.

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          This review summarizes the literature demonstrating that the nonactuarial final risk rating (of low, moderate, or high risk) used by structured professional judgment (SPJ) instruments performs as well as, or better than, numerical or actuarial predictions in terms of their associations with future violence. The chapter also discusses several reasons why this might be the case (i.e., bridging the idiographic and nomothetic levels of analysis).

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        • Hart, S. D., and C. Logan. 2011. Formulation of violence risk using evidence-based assessments: The structured professional judgment approach. In Forensic case formulation. Edited by P. Sturmey and M. McMurran, 81–106. Chichester, UK: Wiley-Blackwell.

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          This chapter discusses important elements of formulation (i.e., theoretically based, spans time) as well as various approaches to formulation (i.e., scenario planning). The chapter also discusses how well (or poorly) various models of risk assessment (i.e., actuarial versus structured professional judgment) can integrate formulation.

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        • Murrie, D. C., M. T. Boccaccini, D. B. Turner, M. Meeks, C. Woods, and C. Tussey. 2009. Rater (dis)agreement on risk assessment measures in sexually violent predator proceedings: Evidence of adversarial allegiance in forensic evaluation? Psychology, Public Policy, and Law 15:19–53.

          DOI: 10.1037/a0014897Save Citation »Export Citation »E-mail Citation »

          The authors analyzed scores by evaluators on opposing sides of adversarial proceedings in sexually violent predator proceedings on three instruments commonly used in such proceedings (Psychopathy Checklist-Revised; Minnesota Sex Offender Screening Tool-Revised; STATIC-99). They report poor agreement between evaluators and discuss the importance of establishing reliability of such instruments when used in the field, particularly in adversarial settings.

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        • Wong, S. C. P., and M. E. Olver. 2010. Two treatment- and change-oriented risk assessment tools: The violence risk scale and violence risk scale-sexual offender version. In Handbook of violence risk assessment. Edited by R. K. Otto and K. S. Douglas, 121–146. New York: Routledge.

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          Wong and Olver discuss two risk assessment instruments, which are intended to be used within a treatment context, to measure reductions of levels of risk factors as a function of treatment. The instruments can not only be used to design appropriate treatment approaches, but also to track progress of offenders throughout treatment. The chapter includes a summary of studies on these instruments.

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        LAST MODIFIED: 01/13/2014

        DOI: 10.1093/OBO/9780195396607-0095

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